Cognitive disposition to respond in postgraduate trainees of general surgery at Rawalpindi Medical University

Introduction: Cognitive biases leading to diagnostic errors are associate with adverse outcomes and compromise patient safety and contribute to morbidity and mortality. Exploration and identification of cognitive biases have been a difficult task for the clinicians and medical educators. The literature is deficient in the identification of cognitive biases in surgical trainees. The objective of the study was to identify various cognitive biases that may negatively impact clinical reasoning skills and lead to diagnostic errors in trainees of general surgery. Materials and Methods: A quantitative study was conducted involving 48 trainees of general surgery to explore the various cognitive biases. The questionnaire was devised and consisted of ten items devised to explore five biases. .Descriptive statistical analysis was done on SPSS 20 and the respondents with score >25 were categorized as predisposed to error scores of 20-25 were taken as a borderline and overall score of <25 was insignificant for the presence of cognitive bias. Results: Premature closure was the most frequent cognitive bias found significant in 34 (70 %) of trainees followed by anchoring bias in 14 (58, 3 %) trainees. The relative frequencies of different biases are shown in Table 2. The mean score of the questionnaire was 22.7 (range 10 to 38) SD 7.2. Ten out of forty-eight (21%) trainees with a mean score of >25 showed a clear inclination toward cognitive errors whereas 11 (22%) with a score in the range of 21 to 25 were categorized as having an equivocal tendency towards committing an error, Whereas 27 (56%) with a score of less than 20 were less prone to cognitive errors. Conclusion: The two most common errors seen in the study were anchoring bias and premature closure and both are related to information gathering. A larger study is required to explore the association of cognitive bias with different specialties and experience of clinicians

Evaluation of Hepatocellular Carcinoma by Gadolinium- Based Contrast Media on MRI

Hepatocellular carcinoma (HCC) is a big cause of death associated with cancer in the world and is the most common liver malignancy. More prevalence of chronic hepatitis virus (primarily chronic hepatitis B and hepatitis C) is attributed to high prevalence in Asia.   Purpose: The purpose of this research was to test gadolinium-based contrast media for hepatocellular carcinoma on MRI.A total of 96 patients from Lahore who visited at radiology department of Al Razi Health Care Hospital from August 2020 to November 2020 for the evaluation of hepatocellular carcinoma by gadolinium based contrast media on MRI.  Results: The study was conducted on 96 patients for the evaluation of hepatocellular carcinoma, out of which 62 were diagnosed with hepatocellular carcinoma. HCC have become a major burden in the world increasing mortality and morbidity. Early identification leads to early treatment and improved survival. Keywords: HCC, HCV, USG, MRI, Gadolinium DOI: 10.7176/JHMN/84-05 Publication date: December 31st 202

Mechanical properties of selected granitoids along the Karora hydropower project, Besham, Northern Pakistan: Insights from petrography and joint analysis

The stability of tunnel site depends upon the deformation behaviors of the surrounding rocks, including joint density, mineral composition, micro cracks, and grain boundaries. The aim of this study was to analyze the mechanical properties of the Besham Complex in Northern Pakistan in terms of petrography and joint analysis. The Besham complex is prone to deformation as it is bounded by the Main Mantle Thrust (MMT) in the north, the Thakot fault (Tf) in the east, and the Swat block in the west. In the study area, the deformation was observed at the mesoscopic scale, while alteration in grains and fractures were determined at a microscopic scale. Detailed petrographic study of the representative samples from each station revealed that the area is dominantly composed of granite, quartz syenite, quartz monzonite, granodiorite, quartz-rich granitoid, monzogranite, alkali feldspar granite, and quartz monzodiorite. Extensive field work was performed to determine the joint volume (JV), in which the number of joints per cubic meter was recorded for each joint set. The rock quality designation (RQD) was calculated through JV analysis. An RQD value <25% suggested that most rocks are very poor quality, while samples with RQD values between 25% and 50% are poor quality. The petrographic analysis revealed that the dominant contents of the rock samples are feldspar (55.6%), quartz (27%), and mica (17.4%). Petrographic control over surface joint volume was established, suggesting that abundant feldspar, coarse grain, anhedral to subhedral grain shape, microcracks, and alteration of minerals provide planes of weakness for joints and thus reduce the RQD value. Therefore, some serious precautions and supporting measurements, such as shotcrete, rock bolts, metal mesh, and steel arch supports, are essential to avoid severe geo-hazards during further excavation.publishedVersio

Garlic as a Potential Nominee in Functional Food Industry

Functional and nutraceuticals products provide a bigger prospect to one’s health by permitting health costs and supporting economic growth in lower and middle developed countries. Because of this reason, mostly diversion of people is going towards functional food and these Phyto-based foods are turning out to be popular universal in the red to the number of statements from researchers for their therapeutic applications. Garlic is one of the ancient vegetables that is used worldwide in different aspects which includes seasoning, culinary purposes, flavoring, and medical purposes. The consumption of garlic word wide increases due to its convenience, tackiness, health benefits, and low side effects. Garlic has been utilized for thousands of years because of its rich active components, phytochemicals, and other Sulfur containing components. It has so much rich history to contribute to the food industry. It has been used as a food stabilizer to prevent the development of pathogens to the prevention of many diseases. The claimed vigor reimbursements of garlic are abundant, including, anticarcinogenic, antibiotic, anti-hypertensive, and cholesterol-lowering properties, the risk of cardiovascular disease lowering the effects of hypolipidemic, antithrombotic, anti-diabetic, antioxidant, antimicrobial, immunomodulatory, antimutagenic, and prebiotic activities. The present attempt of the chapter is to explore garlic history along with its active component’s involvement in the prevention of diseases and threats

Geochemistry and Petrographical Study of Langrial Iron Ore from Tethyan Hazara Area Pakistan, with Emphasis on its Economic Characterization and Depositional Setting

The Langrial iron ore of Hazara area has been studied in detail at five locations for its geochemistry, genesis and economic potential investigations. A maximum of thirty samples were collected from iron ore bodies at different localities of Bagnotar, Danna Noral, Tatti Maira, Najafpur and Jabri for detailed analysis. The thick bedded iron ore has been deposited in the form of unconformity at Cretaceous-Paleocene boundary sandwiched between Kawagarh and Hangu formations (i.e. Cretaceous-Paleocene boundary). At the base of Hangu Formation variable thickness of these lateritic beds spread throughout the Hazara and Kohat-Potwar plateau. These iron ore bodies are studied by X-Ray Diffraction technique (XRD), X-ray Fluorescence Spectrometry (XRF), Petrographic studies and Scanning Electron Microscope (SEM). This XRD analysis indicated that iron bearing minerals are hematite with intercalation of chamosite, quartz and a proportion of impurities having albite, illite-montmorillonite, kaolinite, calcite, dolomite and ankerite. The X-ray Fluorescence (XRF) results show that total Fe2O3 ranges from 30 to 50% having high silica, while alumina to silica ratio is less than 1. The petroghraphic studies revealed concentration of Langrial iron beds as oolitic hematite nodule having variable concentric to composite structure. A high energy shallow marine depositional environment was deduced for Langrial iron ore, as inferred from SEM and mineralogical data. The overall results show that Langrial iron ore is a low-grade iron ore with average Fe2O3 of 52%, and can be upgraded by applying modern mining techniques to fulfill steel requirements of the country

Hydrophilic polymers based sustained release matrix tablets of Ibuprofen: Optimization of formulation using Box-Behnken statistical design

The current study was aimed to formulate sustained release matrix tablets of Ibuprofen; a Propionic acid derivative, and is non-steroidal anti-inflammatory agent (NSAID) with analgesic and antipyretic properties and optimize by using a 3-factor 3-level Box-Behnken statistical design as an optimization tool. Matrix tablets were prepared by direct compression technique using HPMC(X1), NaCMC(X2) and Xanthan Gum(X3) as independent variables and % release at 2hr (Y1), % release at 12hr (Y2) and hardness (Y3) of tablet were selected as dependent variables. Regression analysis was performed on dissolution data and construct polynomial regression models for these response variables. Polynomial models were further validated using ANOVA and results indicate that all the polymers used have significant effect on selected response (p&lt;0.05). Contour plots were drawn to evaluate the effect of polymer combination on selected responses. The results obtained from kinetic modeling indicate that drug release follows the non-fickian diffusion process. Hence Box-Behnken statistical design facilitates the formulation and optimization of Ibuprofen sustained release matrix tablets to achieve better bioavailability. Keywords: Matrix tablets, Sustained release, Ibuprofen, Ant-inflammatory, Box-Behnken statistical desig

Lymphocyte-to-C-Reactive Protein Ratio: A Novel Predictor of Adverse Outcomes in COVID-19.

Background: Systemic inflammation elicited by a cytokine storm is considered a hallmark of coronavirus disease 2019 (COVID-19). This study aims to assess the validity and clinical utility of the lymphocyte-to-C-reactive protein (CRP) ratio (LCR), typically used for gastric carcinoma prognostication, versus the neutrophil-to-lymphocyte ratio (NLR) for predicting in-hospital outcomes in COVID-19. Methods: A retrospective cohort study was performed to determine the association of LCR and NLR with the need for invasive mechanical ventilation (IMV), dialysis, upgrade to an intensive care unit (ICU) and mortality. Independent Results: The mean age for NLR patients was 63.6 versus 61.6, and for LCR groups, it was 62.6 versus 63.7 years, respectively. The baseline comorbidities across all groups were comparable except that the higher LCR group had female predominance. The mean NLR was significantly higher for patients who died during hospitalization (19 vs. 7, P ≤ 0.001) and those requiring IMV (12 vs. 7, P = 0.01). Compared to alive patients, a significantly lower mean LCR was observed in patients who did not survive hospitalization (1,011 vs. 632, P = 0.04). For patients with a higher NLR (\u3e 10), the unadjusted odds of mortality (odds ratios (ORs) 11.0, 3.6 - 33.0, P \u3c 0.0001) and need for IMV (OR 3.3, 95% CI 1.4 - 7.7, P = 0.008) were significantly higher compared to patients with lower NLR. By contrast, for patients with lower LCR (\u3c 100), the odds of in-hospital all-cause mortality were significantly higher compared to patients with a higher LCR (OR 0.2, 0.06 - 0.47, P = 0.001). The aORs controlled for baseline comorbidities and medications mirrored the overall results, indicating a genuinely significant correlation between these biomarkers and outcomes. Conclusions: A high NLR and decreased LCR value predict higher odds of in-hospital mortality. A high LCR at presentation might indicate impending clinical deterioration and the need for IMV